Family Caregivers’ Knowledge of Delirium and Preferred Modalities for Receipt of Information

Delirium is a life-threatening, frequently reversible condition that is often a sign of an underlying health problem. In-hospital mortality alone for older adults with delirium ranges from 25% to 33%. Early recognition of delirium is critical because prolonged duration poses a greater risk of poor functional outcomes for older adults. Family caregivers, who are familiar with the older adult’s usual behaviors, are most likely to recognize delirium symptoms but might dismiss them as due to aging. It is important to learn what family caregivers know about delirium to ascertain their need for education. The aims of this study were to describe family caregivers’ knowledge of delirium and preferred modalities for receipt of information about delirium. A cross-sectional design was used for this study and a survey distributed to family caregivers for older adults. Analysis of 134 usable surveys indicated that family caregivers need and want information about delirium. The preferred modalities for receipt of information included Internet, in-person classes, and newsletters

Public Health Model Identifies Recruitment Barriers among Older Adults with Delirium and Dementia

Recruiting older adults and their family caregivers into research studies presents challenges. Although the literature notes some general recruitment challenges, no studies specifically address the unique challenges of recruiting older adults who have Alzheimer\u27s Disease (AD) and their family caregivers in studies about delirium or suggest using a framework to identify barriers to recruiting this population. In conducting a pilot study about preparing family caregivers to detect delirium symptoms in older adults with (AD) the researchers used the Public Health Model for identifying barriers to recruitment. The goals of this methodological article are to: (1) briefly describe the methodology of the pilot study to illustrate how the Public Health Model was applied in the context of the present study and (2) discuss the benefits of the Public Health Model for identifying the barriers to recruitment in a study that prepared family caregivers to detect delirium symptoms in older adults with AD. The Public Health Model helped us to identify four specific barriers to recruitment (lack of knowledge about delirium, desire to maintain normalcy, protective caregiving behaviors, and older adult\u27s fears) and ways to overcome them. The Public Health Model might also help other researchers address similar issues

Educating Family Caregivers for Older Adults About Delirium: A Systematic Review

Background Delirium in older adults is considered a medical emergency; it contributes to a cascade of functional decline and to increased mortality. Early recognition of delirium symptoms is critical to prevent these negative consequences. Family caregivers who are educated about delirium could partner with nurses and other healthcare professionals in early recognition of delirium symptoms. Before implementing such partnership models, it is important to examine the effectiveness of educating family caregivers about delirium. Aims To examine whether providing education on delirium to family caregivers improved their knowledge, emotional state, or response in reducing the incidence of delirium in older adults. Methods For this systematic review, we conducted literature searches in CINAHL, Cochrane Library, Medline, PsycINFO, Web of Science, Social Sciences in ProQuest, Dissertations and Theses, and the Virginia Henderson Global Nursing eRepository for studies published in the English language between January 2000 and June 2015. Criteria for inclusion were: (a) primary focus on educating family caregivers for older adults about delirium; (b) use of experimental, quasi-experimental, or comparative design; (c) measured family caregiver outcomes of delirium knowledge, emotional state, or response in reducing delirium incidence in older adults; and (d) published in the English language. Articles were appraised using Melnyk\u27s rapid critical appraisal guides. Results Seven studies met the review criteria. Four studies found that family caregivers’ delirium knowledge increased; two noted that delirium incidence in older adults declined; and one study reported less distress following receipt of education. Linking Evidence to Action Providing family caregivers with information about delirium can be beneficial for both family caregivers and older adults. However, rigorous evaluation of education programs for family caregivers about delirium is needed

Numeric and fluid dynamic representation of tornadic double vortex thunderstorms

Current understanding of a double vortex thunderstorm involves a pair of contra-rotating vortices that exists in the dynamic updraft. The pair is believed to be a result of a blocking effect which occurs when a cylindrical thermal updraft of a thunderstorm protrudes into the upper level air and there is a large amount of vertical wind shear between the low level and upper level air layers. A numerical tornado prediction scheme based on the double vortex thunderstorm was developed. The Energy-Shear Index (ESI) is part of the scheme and is calculated from radiosonde measurements. The ESI incorporates parameters representative of thermal instability and blocking effect, and indicates appropriate environments for which the development of double vortex thunderstorms is likely

Engaging Nursing Staff in Research: The Clinical Nurse Specialist Role in an Academic-Clinical Partnership

Purpose: The purpose of this article is to describe the processes of exploring and implementing an academic-clinical study, engaging nursing staff in research, and maintaining their enthusiasm within the context of an academic-clinical research partnership. Description: The core competencies of the clinical nurse specialist (CNS) role address evidence-based practice, quality improvement, and research. Studies and exemplars of the CNS role in the literature illustrate expert practitioner and facilitator of evidence-based practice, but less attention is given to methods used by the CNS to engage staff in clinical research. Outcome: The CNS was successful in obtaining staff engagement in the research project from exploration through sustainment. Conclusion: Collaborative research between academic and clinical partners enhances the educational and professional environment for students and clinicians, promotes evidence-based practice, and from this project may promote Veteran and family-centered care. The CNS played a key role in engaging and sustaining staff commitment, which contributed to the success of this study

Suggestive Guidelines For The Ministerial Internship Training program In The West Indonesia Union Mission Of Seventh-Day Adventists

Problem The ministerial internship program is an important part of ministerial education in the West Indonesia Union Mission of Seventh-day Adventists. The absence of official guidelines for the ministerial internship training program in this area has resulted in the uncertainty of some, if not many, of the supervisors and the supervisees regarding their proper roles in the internship program. Method For the development of guidelines for ministerial internship training, data and information from the following areas have been studied: (1) The undergirding philosophy and the theological principles of supervision based upon the Bible and the relevant literature on field education; (2) a questionnaire to validate the need for guidelines for ministerial internship program sent to the mission presidents of the West Indonesia Union Mission of Seventh-day Adventists; (3) interviews and correspondence with the leaders of the Seventh-day Adventist church in North America, the Far Eastern Division of the General Conference of Seventh-day Adventists, and the West Indonesia Union Mission of Seventh-day Adventists. Recommendations The project suggests the need for well defined criteria of ministerial internship training program and the need for the understanding by the entire church organization including the school, the local mission, the supervisor, and the local parish of the ministerial internship program as a cooperative undertaking

Cosmic rays from trans-relativistic supernovae

We derive constraints that must be satisfied by the sources of ~10^{15} to ~10^{18} eV cosmic rays, under the assumption that the sources are Galactic. We show that while these constraints are not satisfied by ordinary supernovae (SNe), which are believed to be the sources of <10^{15} eV cosmic rays, they may be satisfied by the recently discovered class of trans-relativistic supernovae (TRSNe), which were observed in association with gamma-ray bursts. We define TRSNe as SNe that deposit a large fraction, f_R>10^{-2}, of their kinetic energy in mildly relativistic, \gamma\beta>1, ejecta. The high velocity ejecta enable particle acceleration to ~10^{18} eV, and the large value of f_R (compared to f_R~10^{-7} for ordinary SNe) ensures that if TRSNe produce the observed ~10^{18} eV cosmic ray flux, they do not overproduce the flux at lower energies. This, combined with the estimated rate and energy production of TRSNe, imply that Galactic TRSNe may be the sources of cosmic rays with energies up to ~10^{18}eV .Comment: Accepted to ApJ. Expanded abstract, introduction, discussio

Grover's Quantum Search Algorithm and Diophantine Approximation

In a fundamental paper [Phys. Rev. Lett. 78, 325 (1997)] Grover showed how a quantum computer can find a single marked object in a database of size N by using only O(N^{1/2}) queries of the oracle that identifies the object. His result was generalized to the case of finding one object in a subset of marked elements. We consider the following computational problem: A subset of marked elements is given whose number of elements is either M or K, M<K, our task is to determine which is the case. We show how to solve this problem with a high probability of success using only iterations of Grover's basic step (and no other algorithm). Let m be the required number of iterations; we prove that under certain restrictions on the sizes of M and K the estimation m < (2N^{1/2})/(K^{1/2}-M^{1/2}) obtains. This bound sharpens previous results and is known to be optimal up to a constant factor. Our method involves simultaneous Diophantine approximations, so that Grover's algorithm is conceptualized as an orbit of an ergodic automorphism of the torus. We comment on situations where the algorithm may be slow, and note the similarity between these cases and the problem of small divisors in classical mechanics.Comment: 8 pages, revtex, Title change